Biomedical subjects

Ashok Kumar Mahapatra

Publications and source records attributed to Ashok Kumar Mahapatra.

At least 19 recordsLinked to original sources

PubMed2006

Gemistocytic astrocytomas: histomorphology, proliferative potential and genetic alterations--a study of 32 cases.

Gemistocytic astrocytomas (GAs) are a distinct variant of astrocytomas, generally classified as WHO grade II, and are associated with an aggressive biological behavior. This study was undertaken to determine the histomorphological spectrum, and correlate these with their proliferative potential and genetic alterations, in order to establish a biological basis for their unfavorable prognosis.A total of 32 GAs diagnosed during an 11-year period (1993-2003) were included in the study. Immunoreactivity for CD3 (T-cells), CD20 (B-cells) and CD68 (macrophages) were evaluated to characterize the perivascular inflammatory infiltrates, while p53, epidermal growth factor receptor (EGFR), cyclin D1 and p27-immunolabeling were studied to analyze the tumor biology.Overall, the mean gemistocytic index in the study was 39.6% (range, 12.2-80.8%), with multinucleation in gemistocytes and mitosis being present in 56.2% and 15.6% respectively. Perivascular mononuclear cell cuffing was seen in 56.2% cases, which was immunopositive for CD3 and CD68 in 14 cases each, with 13 cases being immunopositive for both. Similar type of inflammatory infiltrates was also present within the tumor parenchyma. Proliferation index depicted by MIB-1 LI was low (mean: 3.7%; range: 0.5-10.5%), with 70% cases having LI of <5%. MIB-1 labeling was restricted to the small astrocytic cells, similar to p27 and cyclin D1 immunoreactivity, both of which were present in 71.5% cases. In contrast, p53 protein expression was present in 75% cases, and was strongly positive in both gemistocytes and small cells, denoting neoplastic population. However, EGFR protein expression was consistently negative in all cases. Gemistocytes lack proliferative activity possibly indicating terminal differentiation, while small cells are the proliferating cells and their overall percentage may reflect the biological aggressiveness of these tumors and help to identify GAs of higher grade undergoing malignant progression. Therefore it appears that GAs should not be uniformly graded as grade II but should be subdivided into grades II and III neoplasms based on histological features and MIB-1 LI. The poor prognosis in GAs could be attributed both to the high frequency of p53 mutations and low p27 LI.

Adolescent↗

PubMed2006

Have cranio-vertebral junction anomalies been overlooked as a cause of vertebro-basilar insufficiency?

STUDY DESIGN: A prospective controlled study using single photon emission computed tomography (SPECT) to assess cerebellar perfusion in a cohort of 19 patients with congenital cranio-vertebral junction (CVJ) anomalies, with or without vertebro-basilar insufficiency (VBI). OBJECTIVE: To correlate symptoms of VBI with the presence of posterior circulation ischemia in patients with congenital CVJ anomalies, using technetium 99m ethylene cystine dimer SPECT. SUMMARY OF BACKGROUND DATA: Patients with VBI are rarely investigated for CVJ anomalies, despite the fact that a significant number of patients with congenital CVJ anomalies has VBI. There are also no studies quantifying outcome of surgical interventions, such as like occipito-cervical fusion, in patients with VBI and CVJ anomalies. METHODS: There were 19 consecutive patients with congenital CVJ anomalies who were scheduled for combined transoral odontoidectomy and occipito-cervical fusion were included in the study. Technetium 99m ethylene cystine dimer brain SPECT and clinical assessment of all patients was performed in the preoperative period and at 4 weeks after surgery. Before surgery, patients were divided into 2 groups depending on the clinical findings: (1) symptomatic group, consisting of 12 patients having features suggestive of VBI (drop attacks, episodic vertigo, visual disturbances and dysarthria); and (2) control group, consisting of 7 patients without symptoms of VBI. RESULTS: SPECT showed decreased cerebellar perfusion in 75% (n = 9) of patients in the symptomatic group compared to 14% (n = 1) in the control group before surgery (Fisher exact 2-tailed test, P = 0.019). Following surgery, 8 patients (88.9%) in the symptomatic group and none in the control group had improvement in cerebellar perfusion. Two patients in the symptomatic group who had meningitis develop during the postoperative period had a decrease in cerebellar perfusion on follow-up SPECT. Clinically, all patients with improvement in cerebellar perfusion had improvement in the symptoms of VBI at 1 month of follow-up. CONCLUSIONS: A significant number of patients with congenital CVJ anomalies who have symptoms of VBI develop have decreased cerebellar perfusion shown by SPECT. Rigid internal fixation of the CVJ may alleviate symptoms and improve posterior circulation in some of these patients.

Adolescent↗

PubMed2006

Intracranial Rosai-Dorfman disease in a child mimicking bilateral giant petroclival meningiomas: a case report and review of literature.

UNLABELLED: OBJECTIVES AND IMPORTANCE: Rosai-Dorfman disease (RDD) is a rare but distinctive entity of unknown etiology; isolated intracranial RDD is uncommon. Of 37 reported intracranial RDD cases, only three were reported in children. CLINICAL PRESENTATION: We report an unusual case of a 15-year-old boy presenting with 4 months history of raised intracranial pressure with visual deterioration. Computed tomography and magnetic resonance imaging revealed bilateral petroclival enhancing lesions with cavernous sinus extension mimicking meningioma. However, histological examination was diagnostic of RDD. INTERVENTION: The patient underwent extended right-sided middle fossa approach and near-total tumor removal from petroclival region and cavernous sinus on both sides in two stages 6 weeks apart. CONCLUSION: Ours is the first case of pediatric isolated intracranial RDD presenting with giant bilateral petroclival masses successfully managed with bilateral extended middle fossa approach in two stages. An optimal treatment for RDD is not established, but complete surgical resection alone seems effective.

Adolescent↗

PubMed2006

Mycotic aneurysm. an unusual cause of pyrexia of unknown origin in an immunodeficient infant.

Intracranial aneurysms in early childhood are rare. Mycotic aneurysms as a cause of pyrexia of unknown origin has never been reported. We present a 9-month-old immunodeficient boy who had a long history of irregular fever from neonatal period and presented to us with subarachnoid hemorrhage. Investigation revealed a basilar top aneurysm. We present the clinicoradiological profile and discuss the management strategies.

Aneurysm, Infected↗

PubMed2006

Proposal for a new clinicoradiological classification of type I split-cord malformations: a prospective study of 25 cases.

BACKGROUND AND METHODS: Split-cord malformations (SCMs) are rare malformations of the spinal cord. A new classification is proposed based on intraoperative findings in 25 cases of type I SCMs (with bony spur). Patients' demographic profile, radiological and surgical details, complications and outcome were noted. FINDINGS: All patients had type I SCMs. The mean age of the patients was 6.2 years (female:male ratio 1.2:1). Asymmetric lower-limb and sphincter weakness were present in 17/25 (68%) and 5/25 (20%) cases, respectively. Of the symptomatic cases, 29.4% (5/17) showed improvement in motor power and sensory improvement was recorded in 33.3% (4/12) of patients while 40% (2/5) regained continence. No patient in the asymptomatic group (0/8) showed postoperative neurological deterioration. A new subclassification of type I SCM is proposed based on the location of the bony spur responsible for the split, which can affect surgical dissection and outcome. CONCLUSIONS: In SCM patients, the risk of developing neurological deficits increases with age, hence all SCM patients should undergo prophylactic surgery, even if they are asymptomatic. Our new classification is easy to use and takes into account intraoperative findings that may affect surgical outcome.

Adolescent↗

PubMed2006

Outcome of "unknown" head injury patients at a tertiary care neurosurgical centre.

CONTEXT: A large number of patients are admitted to hospitals in large cities without any identification. These "unknown" patients represent a unique problem in developing countries. There is no systematic study in world literature on this subgroup of patients. AIMS: To elucidate the natural history and outcome of traumatic brain injury patients admitted in the department of neurosurgery as "unknowns". SETTINGS AND DESIGN: Retrospective analysis of all traumatic brain injury patients admitted to the department of neurosurgery as "unknown", between January 2002 and March 2005. RESULTS: Three hundred and twenty five patients were admitted as unknowns over a 3 year and 3 months period. Most of the patients were young males and became known during their hospital stay. Overall, 33 patients stayed for longer than one month, with 4 of them staying for longer than 6 months. Mortality in mild, moderate and severe head injury group was 1%, 6% and 46% respectively. CONCLUSIONS: Unknown patients represent a unique subgroup in metropolitan cities like Delhi. Managing them raises several medico-legal issues. Many of them occupy hospital beds for longer duration than required. There is an acute shortage of rehabilitation homes in Delhi for long term care and rehabilitation of such patients.

Adolescent↗

PubMed2005

Mediastinal extension of an intradural teratoma in a patient with split cord malformation: case report and review of literature.

INTRODUCTION: It is very rare for split cord malformation to be associated with intraspinal teratoma, and it is even rarer for such tumors in the dorsal spine to extend into the mediastinum. CASE REPORT: The authors describe a spinal teratoma with mediastinal extension in an 8-year-old boy who presented with 1-year history of backache. Neuroimaging revealed a heterogeneously enhancing intradural lesion from D2 to D7 levels with an extension into the mediastinum at the level of D4 vertebra. A split cord malformation type 2 and a cervical syrinx were also present. At surgery, a reddish-brown vascular tumor was present from D3 to D5 levels and was found to be going anteriorly into a defect in the body of D4 vertebra. Gross total excision of the intraspinal tumor was performed. Follow-up at 1 year revealed no recurrence or metastases. DISCUSSION: To the authors' knowledge, this is the first case of an intradural teratoma extending into the mediastinum, occurring concurrently with split cord malformation and other spinal anomalies.

Cervical Vertebrae↗

PubMed2005

Giant cell glioblastoma multiforme: report of a case with prolonged survival and transformation to gliosarcoma.

INTRODUCTION: Giant cell glioblastomas (GCGs) and gliosarcomas are rare histological variants of glioblastoma multiforme (GBMs). The mean age of occurrence in GCG is 42 years, but occasional cases have been documented in children under 10 years of age. Clinically, they are associated with a better prognosis than conventional GBMs, with few reports documenting prolonged survival up to 17 years after diagnosis. In contrast, gliosarcomas have age distribution and survival characteristics similar to conventional GBMs. They either arise de novo (primary) or secondary to irradiation to GBM. CASE REPORT: We report a rare case of childhood GCG in an 8-year-old boy surviving for more than 10 years since initial diagnosis. He has had two recurrences at the ages of 16 and 17 years, respectively, with histopathology at second recurrence showing evidence of gliosarcoma. DISCUSSION: No such case of gliosarcoma following treatment for GCG has been reported in the literature. Hence, the origin of the gliosarcoma whether radiation induced or only a phenotypic change in the GBM remains conjectural.

Adolescent↗

PubMed2005

Split cord malformations: an experience of 203 cases.

METHODS: A total of 203 patients with split cord malformation (SCM) were operated on at our centre between March 1989 and October 2003. Patients' demographic profile, radiological and operative details, complications and surgical outcome were evaluated retrospectively. RESULTS: The mean age of the patients was 7.4 years and the female to male ratio was 1.3:1. The dorsolumbar and lumbar regions were the most common sites. One hundred thirty-two patients had type I SCM and 71 had type II SCM. One or more skin stigmata were present in 60% cases, hypertrichosis being the most common. Asymmetric weakness of the lower limbs and sphincter disturbances were present in 73 and 33% cases, respectively. Twenty-seven patients were asymptomatic. Of the symptomatic cases, 40.5% showed improvement in motor power, whereas 31% regained continence. The neurological status was unchanged in 48%. Seven percent of the patients showed neurological deterioration immediately after surgery. CONCLUSIONS: SCMs are rare malformations of the spinal cord. We present the largest series so far reported in the world literature. The risk of developing neurological deficits increases with age; hence, all patients with SCM should be surgically treated prophylactically even if asymptomatic.

Child↗

PubMed2005

Expression and structure of interleukin 4 receptors in primary meningeal tumors.

BACKGROUND: It was reported previously that malignant human tumors, like glioma and medulloblastoma, express high-density interleukin (IL-4) receptor mRNA and protein. Because IL-4 receptors (R) are sensitive targets for targeted therapeutics, knowledge of the expression of these receptors in other central nervous system tumors is of great interest. In this study, the authors examined the expression and subunit composition of IL-4R complex in primary human meningiomas. METHODS: Reverse transcription-polymerase chain reaction (RT-PCR) analysis for IL-13Ralpha1, IL-4Ralpha and IL-2Rgammac was performed on total RNA extracted from 35 meningiomas and a normal human brain tissue sample. Results were confirmed in nine randomly selected tumors by quantitative real-time PCR and in situ immunofluorescence assay. RESULTS: Transcripts for the IL-4Ralpha and IL-13Ralpha1 chains were overexpressed in meningiomas compared with normal brain tissue. The levels of IL-4Ralpha mRNA appeared to be higher compared with the levels of IL-13Ralpha1 mRNA. The results also showed that tumors with higher disease grade tended to have increased mRNA expression for the IL-4Ralpha chain. This IL-4Ralpha mRNA overexpression appeared to be more frequent in younger patients (age < 37 years). The transcripts for IL-2Rgammac chain were not detected in any of the tumor samples or in normal brain tissue. Quantitative real-time PCR confirmed the results of the RT-PCR analysis. Meningiomas also demonstrated a bright immunofluorescent staining for the IL-4Ralpha and IL-13Ralpha1 chains but no staining for IL-2Rgammac. CONCLUSIONS: Expression of the IL-4Ralpha and IL-13Ralpha1 chains and absence of IL-2gammac expression established that meningiomas expressed type II IL-4Rs. These receptors may serve as a target for cytotoxin/immunotoxin therapy in patients with meningioma who are not amenable to surgical resection or for recurrent tumors.

Adult↗

PubMed2005

Recurrence in pediatric craniopharyngiomas: analysis of clinical and histological features.

OBJECTIVE: The purpose of this study was to investigate the recurrence pattern and significance of various clinical and histological features as predictors of recurrence in pediatric craniopharyngiomas. METHODS: A series of 116 pediatric craniopharyngiomas (68 boys and 48 girls; age range, 1.6-18 years) was reviewed. Mean follow-up period was 18.53 months. Tumors recurred in 15 patients within 96 months [mean recurrence-free survival (RFS), 12.67 months]. Of the recurrence cases, 2 had complete (mean RFS, 16 months) and 13 had subtotal tumor excision (mean RFS, 9.03 months). Histologically, an adamantinous pattern was seen in 95% of cases, whereas a papillary pattern was noted in 5%. Brain tissue was included in 41 cases. In 32 of 41 cases, brain invasion was noted, and all were of adamantinous histology. No correlation was noted of histopathological subtyping or brain invasion with recurrence. CONCLUSIONS: The significant clinical factors associated with recurrence included extent of resection, tumor size >4 cm, and cystic tumors.

Adolescent↗

PubMed2005

Adult complex spinal dysraphism with situs inversus totalis: a rare association and review.

STUDY DESIGN: First published report of an adult complex spinal dysraphism with situs inversus. OBJECTIVES: To describe a previously asymptomatic adult patient of multiple vertebral anomalies with cervical split cord malformation type II, tethering of the spinal cord (cervical and lumbar), and intraspinal arachnoid cyst along with dextrocardia and situs inversus. SUMMARY OF BACKGROUND DATA: Only 5 cases (fetus, 1; neonates, 3; child, 1) of spinal dysraphism with dextrocardia or situs inversus have been reported. All these cases have had associated multiorgan developmental anomalies usually incompatible with survival and requiring multidisciplinary care. METHODS: The case has been described and relevant literature reviewed. RESULTS: The patient was operated for cervical and lumbar levels in the same sitting. A C4-C5 laminectomy was performed, 2 hemicords enclosed in the same dural sac were visualized, dorsal paramedian nerve roots and the tethering arachnoid bands were cut, and the arachnoid cyst wall was partially excised. This was followed by L4-L5 laminectomy and detethering by sectioning of the thickened filum terminale. The patient showed significant neurologic improvement after surgery. CONCLUSIONS: The present case is a rare instance in which there has been an association of adult onset occult spinal dysraphism along with situs inversus totalis. Successful management requires appropriate understanding of embryology, anatomy, and imaging and has implications in neurosurgical and perioperative anesthetic care.

Abnormalities, Multiple↗

PubMed2005

Intraventricular rhabdoid tumor.

Malignant rhabdoid tumor (MRT) most commonly occurs in kidney. In the central nervous system, cerebellum is the most common site of occurrence. CNS rhabdoid tumors typically occur in small children, do not respond favorably to treatment and are usually fatal within 1-year. Here is reported a 4-year-old child who presented with features of raised intracranial pressure. Apart from papillodema, there were no neurological signs. Imaging revealed a left lateral ventricular heterogeneous mass abutting the foramen of monro, with mild irregular contrast enhancement and hydrocephalus. The child underwent right ventriculo-peritoneal shunt followed by craniotomy and gross total tumor resection. He was discharged 10-days after surgery without any neurological deficits. Histopathology revealed features compatible with rhabdoid tumor. Despite radiotherapy and chemotherapy, the child died of progressive disease 10-months after surgery. The highly malignant nature of this tumor makes early diagnosis essential for aggressive management and prognostication.

Cerebral Ventricle Neoplasms↗

PubMed2005

Apoptosis and proliferation: correlation with p53 in astrocytic tumours.

Apoptosis and cell proliferation occur simultaneously in tumour tissue with tumour suppressor gene, p53 being one of the key players in the complex relationship between these two key phenomena. We, as well as several other groups, have earlier demonstrated the association of p53 immunopositivity with increased degree of cell proliferation in astrocytic tumours. Here we have studied the extent of apoptosis in 62 primary human astrocytic tumours [25 Diffuse Astrocytoma (DA), 9 Anaplastic Astrocytoma (AA) and 28 Glioblastoma multiforme (GBM)] in relation to tumour grade, proliferative status and p53 protein expression. Apoptosis was measured by the TUNEL assay while, cell proliferation (MIB-1 index) and p53 protein immunoreactivity were evaluated by immunohistochemical staining using MIB-1 and DO-1 monoclonal antibodies respectively. The apoptotic index (AI) was greater in GBM than in AA or DA, and more in tumours with p53 immunopositivity than in those without. The most striking observation was the strong correlation between Apoptotic index (AI) and proliferation index (PI) in p53 negative GBM (r=0.766, P < 0.005). However this was not observed in p53 +ve GBM or in low grade DA either p53 positive or negative. Taking p53 negativity in IHC as evidence of a functional gene/protein, this extends the link between proliferation and apoptosis, hitherto observed only in cultured cells with functional p53, to a subset of solid tumours.

Apoptosis↗

PubMed2005

Vertically acquired neonatal citrobacter brain abscess - case report and review of the literature.

Vertically acquired citrobacter meningitis in the neonate is very rare and carries a very high mortality and morbidity. Overall, approximately 30% of neonates with Citrobacter meningitis die and 50% sustain some damage to the CNS. The authors describe a case of a newborn with Citrobacter koseri meningitis with multiple brain abscesses, with a successful outcome following multiple burr-hole aspirations and prolonged antibiotic therapy. An aggressive surgical approach combined with intravenous antibiotics (including imipenems, to which the organism is very sensitive) for a minimum of 4 weeks appears to improve the outcome of infection with this virulent organism.

Anti-Bacterial Agents↗

PubMed2005

Terminal myelocystocele.

Myelocystocele is a variety of occult spinal dysraphism that is characterized by a localized, cystic dilatation of the terminal part of the central canal that then herniates through a posterior spina bifida. We describe a series of eight cases of myelocystocele. The clinical and radiological features and treatment are discussed and the relevant literature reviewed.

Child, Preschool↗

PubMed2005

Unusually long survival in a case of medullomyoblastoma.

Medullomyoblastoma is a rare variant of medulloblastoma containing a component of striated and smooth muscle with survival of 3 to 4 years following surgery and radiotherapy. The authors report a rare case of medullomyoblastoma with an unusual survival of over 11 years without recurrence. The relevant literature is briefly reviewed.

Cerebellar Neoplasms↗

PubMed2005

Visual outcome of blind eyes in pituitary apoplexy after transsphenoidal surgery: a series of 14 eyes.

BACKGROUND: To study the visual outcome of patients who became blind after an episode of pituitary apoplexy and who subsequently underwent emergency transsphenoidal decompression of the optic apparatus, and to identify factors that may have a bearing on the visual outcome in such patients. METHODS: Twenty-three patients underwent transsphenoidal surgery for pituitary apoplexy over a 5-year period at the All India Institute of Medical Sciences. Among them, 8 (35%) presented with visual deterioration to monocular (n = 2) or binocular (n = 6) blindness after the apoplectic episode. There were 7 males and 1 female with the average age of patients being 43 years. The mean delay between the apoplexy and neurosurgical consultation was 10 days, with a range of 4 to 30 days. The adenoma was classified as "giant" in 4 and multicompartmental in 2 patients. After surgery, all patients had a minimum follow-up of 3 months. RESULTS: Four patients (50%) had improvement in vision to greater than 2/60 (Snellen's), including 2 patients whose vision improved to 6/6. All patients in whom there was improvement in vision had been operated on within a week of the apoplectic episode. CONCLUSIONS: This study shows that even completely blind eyes may have remarkable improvement in vision if surgical decompression of the optic apparatus is undertaken early. Awareness regarding pituitary apoplexy and reversibility of vision loss needs to be increased among the medical community, especially ophthalmologists and physicians, so that timely neurosurgical intervention can occur.

Adenoma↗